tag:blogger.com,1999:blog-89449731453550551642014-10-07T02:13:20.924+01:00Think About HealthSimon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comBlogger38125tag:blogger.com,1999:blog-8944973145355055164.post-54901998462328885362014-03-24T14:27:00.000+00:002014-04-11T10:44:11.836+01:00Summer 2014 Conference<br /><br /><div class="WordSection1"><div align="center" class="MsoNormal" style="margin-right: 1.25pt; text-align: center;"><b><span style="color: #5588aa; font-size: 18.0pt; mso-ascii-font-family: Calibri; mso-bidi-font-family: Arial; mso-hansi-font-family: Calibri;">Summer 2014 Conference<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="margin-right: 1.25pt; text-align: center;"><br /></div><div align="center" class="MsoNormal" style="margin-right: 1.25pt; text-align: center;"><b><span lang="EN" style="color: #5588aa; letter-spacing: 1.2pt; text-transform: uppercase;">Flourishing in Difficult Times<span style="font-size: large;"><o:p></o:p></span></span></b></div><div class="MsoNormal" style="margin-right: 1.25pt;"><br /></div><div align="center" class="MsoNormal" style="margin-right: 1.25pt; text-align: center;"><b><span lang="EN" style="color: #5588aa; letter-spacing: 1.2pt; text-transform: uppercase;">19<sup>th</sup> to 20<sup>th</sup>June 2014<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="margin-right: 1.25pt; text-align: center;"><b><span lang="EN" style="color: #5588aa; letter-spacing: 1.2pt; text-transform: uppercase;">Woodbrooke Quaker Study Centre, Birmingham <span style="font-size: medium;"><o:p></o:p></span></span></b></div><div class="MsoNormal"><br /></div></div><span style="font-size: 11.5pt; line-height: 13pt;">What does it mean for a health service to flourish?&nbsp;</span><br /><div class="MsoNormal" style="line-height: 13.0pt; margin-bottom: 10.0pt;"><span style="font-size: 11.5pt;"><br /></span><span style="font-size: 11.5pt;">How might a sense of flourishing underpin other goals, such as building a just and compassionate service?<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 13.0pt; margin-bottom: 10.0pt;"><span style="font-size: 11.5pt;">How can both patients and practitioners be helped to flourish in the face of adversity?&nbsp; <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 13.0pt; margin-bottom: 10.0pt;"><span style="font-size: 11.5pt;">The 2014 Think about Health Conference will address the conceptual and practical problems of flourishing in health care.<b><o:p></o:p></b></span></div><br /><b>For more information about the conference, including keynote speakers and how to attend, follow&nbsp;<a href="http://www.thinkabouthealth.net/p/summer-2014-conference-flourishing-in.html" target="_blank">this link</a>&nbsp;or download the conference pack <a href="https://drive.google.com/file/d/0B1Ni-H3C2ViTa3dCQjZPcHF6eUE/edit?usp=sharing" target="_blank">here</a>. &nbsp;You can now book tickets online <a href="http://www.eventbrite.co.uk/e/flourishing-in-difficult-times-tickets-11266794285%20" target="_blank">here</a>.</b>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-56644843509427780402013-08-18T09:49:00.000+01:002013-08-18T09:50:53.831+01:00Think About Health<span style="color: #666666; font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;">'Think about health is a jewel. It is rare and valuable. There are so few places where it is possible to explore issues in depth and breadth in the way the TAH conferences and day events allow.&nbsp;</span><br /><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;">The combination of philosophers with clinicians and managers and interested academic/consultants ensures that the discussion is relevant but also genuinely thought provoking and a link to a rich &nbsp;treasury of reading and other resources.&nbsp;</span><br /><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;">It is wonderful to have a space where academic disciplines can contribute to the thinking of those of us more directly involved with solving society's problems.'&nbsp;</span><br /><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="color: #666666; font-family: Arial, Helvetica, sans-serif;">Valerie Iles (founding member Think about Health)</span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-5453134145853347402013-04-16T22:01:00.002+01:002013-08-18T09:51:40.442+01:00What is Think About Health?<div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-indent: 36pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">Think About Health is a group of philosophers, clinicians and managers who believe it is important to do just that: think, really think, about health and its care. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">We offer a space for passionate , intelligent discussion, supported and provoked by rich and rigorous ‘think pieces’,&nbsp; in which to explore alternative ways of thinking about health care provision, and our experience within the health care system, and our practices as health care professionals.&nbsp; We are looking for ways to articulate what is happening in health care,&nbsp; for new ways to reflect upon and talk about who we are and what the NHS is.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">At the root of our work are our conferences. These aim to stand out from all the rest&nbsp; in offering opportunities to go beyond the usual simplistic prescriptions and unexamined assumptions. They are unashamedly intelligent and passionately committed. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">They have been called ‘jewels’. They allow those concerned about the direction and destiny of the NHS to discuss, openly and freely, in a reflective and friendly atmosphere - and leave seeing the world slightly differently. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">Typically people talk of how enriching it is to feel&nbsp; part of a community of people interested in ways of thinking, valid and coherent&nbsp; ways of looking at the world that lie beyond&nbsp; the mainstream management world view.&nbsp; <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /><span style="color: #666666;">The conferences and workshops are what we are about. They are different from what everyone else is doing, so if you want to be different, to have the opportunity to think freshly then come along .... &nbsp;Participants to our events have commented that it is an "Excellent experience to have multidisciplinary input in such a welcoming and 'kind' atmosphere", and offered 'a general thank you for the space to consider... issues, not just in a 'chat' like with friends but drawing from different areas of knowledge.</span><br /><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">In between these conferences our website aims to keep the spirit alive. Have a look at our Luminous Words project and please feel free to submit a description of your own luminous word.</span><br /><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;"><br /></span><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">You may also like to browse these links to the thinking of some of our members:</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br /></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">Members of the network, such as Stephen Pattison and Andrew Edgar (writing on integrity (<a href="http://onlinelibrary.wiley.com/doi/10.1111/nup.2011.12.issue-2/issuetoc">here</a></span><span class="MsoCommentReference"><span style="font-size: 8.0pt;">&nbsp;</span></span><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">)),&nbsp; Val Iles (on health care reform (<a href="http://www.reallylearning.com/Free_Resources/Really_Managing_Healthcare/why-reforming-nhs-book.html">here</a>)), and Andrew Edgar (on the political philosophy of health (<a href="http://books.google.co.uk/books?id=BG8XVEaZ5hAC&amp;printsec=frontcover#v=onepage&amp;q&amp;f=false">here</a>)) have begun to explore new ways of discussing health care.</span><br /><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">.</span><br /><span style="color: #4f81bd; font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;; font-size: 10.0pt; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-fareast-font-family: &quot;Times New Roman&quot;; mso-fareast-language: EN-GB; mso-themecolor: accent1;">For a personal account of his involvement in Think about Health, see the convenor's comments <a href="https://docs.google.com/file/d/0B1Ni-H3C2ViTOXJ3b1BpdUgxaFU/edit?usp=sharing" target="_blank">here</a>.</span></div><div><div><div class="msocomtxt" id="_com_2" language="JavaScript"><!--[if !supportAnnotations]--></div><!--[endif]--></div></div></div><div><div><div class="msocomtxt" id="_com_1" language="JavaScript"><!--[if !supportAnnotations]--></div><!--[endif]--></div></div>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-5716596262032671522011-07-23T12:40:00.003+01:002011-07-23T12:47:37.999+01:00New Book by Think About Health Member<br/><span style="font-family:verdana;">Former member of the executive committee Val Iles has published a new book: “Why Reforming the NHS Doesn't Work: the importance of understanding how good people offer bad care”.<br /><br />Drawing on the insights of a dozen observers of the NHS from fields including sociology, anthropology, history, moral and political philosophy, and psychology, “Why Reforming the NHS Doesn't Work” argues that attempts at reform have so far exacerbated the problem, and offers a vision of what might be done instead.<br /><br />Val is an independent academic consultant in the field of health management, working with a number of universitiesand organisations across the NHS.<br /><br />She has contriubted to several events organised by the Think About Health network, most recently delivering a talk entitled "Has the Public Sector been captured by the vested interests of economists?" at our conference <em><a href="http://www.thinkabouthealth.net/2011/04/climatic-change-in-nhs-values-what.html">Climatic Change in NHS Values – What Happens “The Day After Tomorrow”?</a></em><br /><br />To download a copy of the book from Val's website, click </span><a href="http://www.reallylearning.com/Free_Resources/Really_Managing_Healthcare/why-reforming-nhs-book.html"><span style="font-family:verdana;">here</span></a><span style="font-family:verdana;">.</span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-36137880246436558502011-04-21T13:56:00.009+01:002011-06-05T14:17:57.599+01:00Special Issue of Nursing Philosophy Follows Up on our 2009 Symposium<br>The April 2011 issue of the journal <a href="http://www.wiley.com/bw/journal.asp?ref=1466-7681">Nursing Philosophy</a> is edited by our former chair, Stephen Pattison, and current convenor, Andrew Edgar, and is dedicated to the notion of integrity.<br /><br />Much of the debate contained within this special issue began at the Think About Health's Autumn 2009 symposium "<a href="http://www.thinkabouthealth.net/2008/07/think-about-health-conference-2009.html">Integrity in Health Care: Changing Roles and Relationships</a>", and contributions from Stephen Tyreman and Alan Cribb follow up their presentations to that meeting. In addition to the editors, along with Stephen and Alan, the contributors include Karen Sanders, Brian Hurwitz and Vigdis Ekeberg. The contributions range from a description of the way in which targets and managerialism within A&amp;E nursing compromise professional dignity, through reflections on the meaning of the term and the way in which it is manifest as a response to the challenges of professional life, to discussion of the place of integrity in psychiatric nursing care.<br /><br />While the authors approach the problem from different perspectives, all share a recognition of the importance of the concept, but also its subtlety and complexity. Integrity is irreducible to codes or simple formulae of good practice. It lies less in the clear sighted moral certainty of the individual, than in that individual’s ability to negotiate and discuss with others, to recognising competing understandings of the moral, as well as the concrete practical demands of professional practice. In sum, it is less moral vision than the development of a competence or virtue; to recognise and respond constructively to a need for compromise, as much as it is the strength to protest.<br /><br />The contributors to this special issue hope to demonstrate the importance of ‘integrity’ as a focus for debate, and a way of understanding the demands and limitations of professional practice.Simon Walthonoreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-32319882946204287682003-01-31T18:02:00.017+00:002012-07-16T16:43:27.553+01:00The Luminous Words Project<span style="font-family: Verdana;"><i></i></span><br /><span style="font-family: verdana;"><i>by Stephen Pattison and Val Iles</i></span><br /><br /><span style="font-family: verdana;">The Luminous Words Project was first suggested at our Autumn 2010 Meeting <a href="http://www.thinkabouthealth.net/2010/04/language-in-health-care-inspiring-or.html">"Language in Health Care: Inspiring or Dispiriting?".</a> Attendees felt that there were a lot of words that seemed essential to health care (not least the words ‘health’ and ‘care’!) that seem in some way to be marginalised.<br /><br />So, we thought it would be illuminating, participatory, and fun to begin to create a kind of “Angel’s Thesaurus” of “luminous” words that we find important but neglected – and perhaps also a “Devil’s Thesaurus” of their tawdry or non-luminous equivalents!<br /><br /><b>How does the Project work?</b></span><br /><br /><span style="background-color: white; font-family: verdana;">Every month, the Project co-ordinators ask someone to write about a new word every to start off a thread; Think About Health members will be alerted to the word of the month by e-mail, and are invited to add their own thoughts, stories, narratives, poems and comments to the original blog in the spirit of being constructive.<br /><br />We are not particularly interested in creating flat contradictions or acerbic critique but rather in seeing whether we can positively rehabilitate and make more creative and illuminating the vocabulary around health without being anodyne, unrealistic or uncritical.<br /><br />Contributions around particular words do not need to refer to each other, but they can diverge and be tangential, and we would welcome words and comments that are illuminatingly opaque – the only criterion we ask people to bear in mind is that we are trying to be constructive, even if oblique. We hope this will be valuable for members frequenting the site – and that it might help a wider audience to see things differently.</span><br /><br /><span style="background-color: white; font-family: verdana;">A list of existing articles can be found below, or by clicking the link on the left-hand side of the page. Recent Contributors have included Iona Heath (<a href="http://www.rcgp.org.uk/contact_us/college_officers/president.aspx">President of the Royal College of General Practitioners</a>), John Gillies (<a href="http://www.rcgp.org.uk/contact_us/college_officers/chair_of_scottish_council.aspx">Chair of Scottish Council for the Royal College of General Practitioners</a>), and Jane McNaughton and H. M. Evans (Co-Directors of the <a href="http://www.dur.ac.uk/cmh/">Centre for Medical Humanities at Durham University</a>).</span><br /><br /><span style="background-color: white; font-family: verdana;">If you want to discuss the project in more detail, or suggest a word of your own, please contact either Val Iles </span><span style="background-color: white; font-family: verdana;">and/or Stephen Pattison at <a href="mailto:luminouswords@thinkabouthealth.net">luminouswords@thinkabouthealth.net</a></span><span style="background-color: white; font-family: verdana;">.</span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-84745235398207183392003-01-30T18:02:00.000+00:002013-07-29T12:42:19.675+01:00Luminous Words Project: All Articles<br /><br /><a href="https://docs.google.com/file/d/0B1Ni-H3C2ViTTXo4RnRoUlN1dUU/edit?usp=sharing" style="font-family: Verdana, sans-serif;">Compassion</a>&nbsp;<span style="font-family: Verdana, sans-serif;">-&nbsp;</span><i style="font-family: Verdana, sans-serif;">by Andrew Edgar</i><br /><span style="font-family: Verdana, sans-serif;"><a href="http://www.thinkabouthealth.net/2003/09/luminous-words-quiet.html">Quiet</a> - <i>by Iona Heath</i></span><br /><a href="http://www.thinkabouthealth.net/search/label/Luminous%20Words%20Articles" style="background-color: white; font-family: verdana;">Personal</a><span style="background-color: white; font-family: verdana;">&nbsp;</span><span style="background-color: white; font-family: verdana;">-</span><span style="background-color: white; font-family: verdana;">&nbsp;</span><em style="background-color: white; font-family: verdana;">by Jamie Harrison</em><br /><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-judgement.html" style="font-family: verdana;">Judgement</a><span style="font-family: verdana;">&nbsp;</span><span style="font-family: verdana;">-</span><span style="font-family: verdana;">&nbsp;</span><em style="font-family: verdana;">by John Gillies</em> <br /><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-flourishing.html" style="font-family: verdana;">Flourishing</a><span style="font-family: verdana;">&nbsp;</span><span style="font-family: verdana;">-</span><span style="font-family: verdana;">&nbsp;</span><em style="font-family: verdana;">by Val Iles</em> <br /><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-humility.html" style="font-family: verdana;">Humility</a><span style="font-family: verdana;">&nbsp;</span><span style="font-family: verdana;">-</span><span style="font-family: verdana;">&nbsp;</span><i style="font-family: verdana;">by Jane Macnaughton</i><br /><a href="http://www.thinkabouthealth.net/2011/12/luminous-words-wonder.html" style="font-family: verdana;">Wonder</a><span style="font-family: verdana;">&nbsp;</span><i style="font-family: verdana;">- by H M Evans</i> <br /><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-presence.html" style="font-family: verdana;">Presence</a><span style="font-family: verdana;">&nbsp;</span><span style="font-family: verdana;">-</span><span style="font-family: verdana;">&nbsp;</span><em style="font-family: verdana;">by Elizabeth Barrett</em> <br /><span style="font-family: verdana;"><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-death.html">Death</a>&nbsp;-&nbsp;<em>by Andrew Edgar</em></span><br /><a href="http://www.thinkabouthealth.net/2003/01/luminous-words-1-vocation.html" style="font-family: verdana;">Vocation</a><span style="font-family: verdana;">&nbsp;</span><span style="font-family: verdana;">–</span><span style="font-family: verdana;">&nbsp;</span><em style="font-family: verdana;">by Stephen Pattison and Val Iles</em>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-5675912034634505272003-01-09T14:53:00.000+00:002013-07-29T12:38:37.396+01:00Luminous Words: Compassion<br /><br />Compassion<br /><br />The concept of ‘compassion’ has recently gained a high profile with debate over health care provision. &nbsp;Responses by the government and by the press to the Francis report into the shortcomings of the Mid-Staffordshire NHS Foundation Trust have made much of the apparent lack of compassion shown by nurses and other health care providers. &nbsp;There is nothing new in the caring professions’ recognition of the place of compassion as one of their core values, and if anything the Francis report reminds us, not of the importance of the compassion, but of the danger of forgetting its primacy or forgetting how to express compassion in practice.<br /><br />In recent Think about Health discussions of compassion, at the June 2013 one-day conference held in association with the Royal College of General Practitioners (Scotland) and at our principal 2013 conference in Birmingham, I was pleasantly surprised by how robust a concept ‘compassion’ has turned out to be. &nbsp;Despite rigorous and critical debate, it continues to yield insights into the nature of professional care, and to provide an exacting standard against which to evaluate that care. &nbsp;There remain, without doubt, dangers that the concept can be trivialised and subordinated to the very tick-box culture that it is invoked to frustrate. &nbsp;‘Compassion’, like ‘dignity’ before it, might be operationalised as a list of discrete behaviours, with compliance being readily quantifiable. &nbsp;Already in 2008, the then health secretary Alan Johnson proposed that nurses should be rated on how compassionate and ‘smiley’ they are. <br /><br />‘Compassion’ may resist such crude attempts to operationalise it precisely because of its depth and significance. &nbsp;It is broadly agreed, not least on the authority of the Dalai Lama, that compassion entails two components: a sensitivity to the suffering of others and the commitment to relieve that suffering. &nbsp;To be compassionate thus entails a capacity to suffer with another, feeling, to some degree, their pain and distress, alongside the motivation to alleviate that pain. &nbsp;Doctors and nurses (and one may hope, many others who work in the NHS in all sorts of positions) are compassionate. &nbsp;They enter the NHS typically because they are sensitive to the suffering of others and want to do something to alleviate that suffering. &nbsp;Against crude quantification and the Taylorist mentality of the tick-box culture, compassion sustains the carer’s sensitivity to the qualitative unique experiences and needs of the patient before them.<br /><br />Yet, not all who work in the NHS are compassionate, or at least, their compassion and sensitivity to suffering of others gets blunted. &nbsp;Mid-Staffs, tragically, demonstrated this. &nbsp;Perhaps the problem with compassion lies in how burdensome it can become. &nbsp;Burnout, a long recognises malaise of the caring professional, may in part be due to this burden. &nbsp;A compassion fatigue of sorts may set in, precisely as the burden of caring becomes too great. &nbsp;A problem may lie in a certain ambiguity in the description of compassion offered above. &nbsp;The compassionate person suffers with the patient. &nbsp;They are motivated to remove this suffering. &nbsp;It is here that the ambiguity lies, for one may remove one’s own discomfort – one’s own burden of suffering – by either alleviating the pain of the patient, or by protecting oneself from it – hardening and blinding oneself to the other’s pain. &nbsp;The moment I cease to suffer sympathetically I relieve my own burden, and I do so regardless of what has happens to the patient. <br /><br />Such callousness may seem easy to condemn. &nbsp;However, professional carers do need a certain distance from their patients, and techniques to let go of those sympathetic feelings. &nbsp;To sympathise too closely with the suffering of another will inhibit the carer’s capacity to act effectively and professionally. &nbsp;Further, if that distance is not there, then the threat of burn out will be intense. &nbsp;An equilibrium is required, but such equilibrium rests as much upon the carer’s environment as it does upon their internal, psychological resources.<br /><br />In certain environments, the suffering of the patient may never seem to be relieved. &nbsp;The patient’s condition may indeed be chronic and worsening, and there is seemingly nothing that the carer can do nothing to help. &nbsp;More drastically, perhaps, an inappropriate organisation of duties and hospital wards prevents the carer from ever seeing the patient’s recovery. &nbsp;They have always been moved on, or you have been reallocated. &nbsp;Perhaps the resources, equipment, drugs or staffing numbers, that are required to relieve suffering are simply not there. <br /><br />Paradoxically, it is conceivable that it is the most compassionate and highly motivated carers who are most vulnerable to the sort of callousness that I have outlined. &nbsp;Perhaps the most compassionate are the most vulnerable to burnout, and those that survive in adverse circumstances are the most likely to become cynical and blind to the suffering around them. <br /><br />A staff of compassionate carers cannot then be guaranteed just by the provision of training early in their careers, or even by the careful selection of recruits into the caring professions. &nbsp;A compassionate staff requires continual support, and the clear articulate of reasonable expectations as to what can and not be achieved. &nbsp;Such staff need the time and resources, not least in terms of the support of the colleagues and employers, to balance compassion for others and compassion for themselves, and to reflect upon their practice. &nbsp;Initiatives, such as Schwartz rounds, already exist. &nbsp;Crucially, compassion is therefore not a quick or cheap fix for the ills of the NHS. &nbsp;It is a demand that can simply be imposed upon smiley carers, but rather as product of the careful &nbsp;organising of the systems that facilitate care, and that support the carers. <br /><br />Compassion is a robust concept. &nbsp;Its importance, both in professional ethics and professional psychology, lies in the demands that it makes upon us to continue to think radically about what care is, and what it demands from the carer and the systems that support them.<br /><br /><br />(As everyone who was there will have realised, in putting together these reflections I have drawn freely on the wonderful insights of the contributors to the Think about Health ‘Compassion Fatigue’ conference. &nbsp;I thank all the speakers, workshop convenors, and delegates for the success of that conference.)<br /><br /><br />Andrew Edgar<br />Convenor – Think about Health<br /><div><br /></div>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com0tag:blogger.com,1999:blog-8944973145355055164.post-70601649046026566462003-01-08T12:13:00.000+00:002012-05-08T12:15:29.292+01:00Luminous Words: Personal<br /><span style="font-family: Verdana, sans-serif;"><em>by Jamie Harrison</em></span><br /><br /><span style="font-family: Verdana, sans-serif;">Recently I was offered the possibility of having a ‘personal banker’, someone I was led to believe would be available to give timely financial advice and smooth any transactions that I might need to complete. It sounded good – a dedicated person (with a name) who would answer the phone when I rang, rather than finding myself caught in an automated system forever asking me to press a number, ‘followed by hash’, within an endless round of options leading nowhere.</span><br /><span style="font-family: Verdana, sans-serif;">So, I ask, have the banks for once got it right? – Could it be that a personal service provided by a ‘real’ person is the future as well as a reflection on the past, a time when the Bank Manager was a person you knew (and probably feared) – perhaps one of Alasdair MacIntyre’s ‘characters’ – and where others in the team were approachable folk who phoned you back when you left a message? How many of us can remember that?</span><br /><span style="font-family: Verdana, sans-serif;">I vividly remember Dennis Pereira Gray reminding us thirty years’ ago&nbsp; that, once doctors and patients lost the habit of meeting each other regularly (with the demise of what he saw as an individual GP’s Patient List), then neither would know what they were missing – it might be bad for doctors and it might be bad for patients. Of course, we must acknowledge that familiarity can breed contempt (or lead to the doctor missing the slow and subtle changes of disease – hypothyroidism is usually quoted here). Yet the ability to meet in the consulting room in both fair weather and foul might allow a depth of rapport and mutuality to flourish, even with the ‘heart-sinks’; at least you both knew you had to sort it out together. </span><br /><span style="font-family: Verdana, sans-serif;">Recent pressures to limit hospital working hours for doctors, with the resulting loss of the close-knit consultant-led team (firm), and the fragmentation of primary care appointment provision (one perverse consequence of the 48-hour access requirement), mean that it is harder for clinicians and their clients to keep in direct touch – where ‘touch’ itself may add greatly to the healing and appropriate bonding that both parties need. In the personal interaction much of our shared humanity can be expressed and experienced by the kind word, the supportive glance, the held hand, the pulse taken, and the prescription (gift) offered.</span><br /><span style="font-family: Verdana, sans-serif;">In struggling to make sense of what might be termed the ‘hermeneutics of healthcare’ – how we seek to describe, interpret, and make sense of what goes on in the interaction between health-carers and their patient clients – the nature of the personal can be overtaken by the desire to measure transactions, rather than look for transformations. Michael Balint, in his book initially titled ‘The Doctor, His Patient and the Illness’, is careful to ask how we might see lives supported, even changed, through personal therapeutic interactions which may not fit easily into scientific medical models of diagnosis and treatment.&nbsp; To borrow an updating of his book title to the present day – now ‘The Practice, the Population, and the Public Health’ - reminds us that the shift to systematised medicine (to quote Illich) risks dehumanising all parties concerned.</span><br /><span style="font-family: Verdana, sans-serif;">I wonder if I rather like the idea of my ‘personal banker’ – she may get it wrong but at least we can get it wrong together. In seeking a person with whom I can interact – some one, who is available, takes me seriously and takes responsibility - I hark back to past ages of personal physicians who were there for you and told you the score; who travelled with you through life’s ups and downs (both yours and theirs), and who might journey with you to life’s end, what Illich (again) refers to as the amicus mortis – ‘one who tells you the bitter truth and stays with you to the inexorable end’ (BMJ, 1995). </span><br /><span style="font-family: Verdana, sans-serif;">‘Personal’ care can, of course, be as much an attitude of mind, as I seek to meet you and your concerns, even if for the first time, with a genuine and generous spirit. Yet how we organise ourselves within our healthcare settings would seem to make that either easier or more difficult. Where there is an emphasis on systematic care, the personal may be lost; too much personal discretion can lead to poor standards of practice.&nbsp; How to get the mix right? Surely one answer is to find ways of encouraging person-to-person continuity within proper frameworks of clinical governance, where the expectation and ethos is that persons really do matter.</span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com0tag:blogger.com,1999:blog-8944973145355055164.post-45934700993552788152003-01-07T17:17:00.002+00:002012-03-02T17:03:51.668+00:00Luminous Words: Judgement<br/><em><span style="font-family: Verdana, sans-serif;">by John Gillies</span></em><br /><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><i><span lang="EN-US"><span style="font-family: Cambria;">The phone call came about midnight on a cold March night. I was the GP<span style="mso-spacerun: yes;">&nbsp; </span>in the out of hours car. The caller said that her husband Billy, who was 45 years old, had<span style="mso-spacerun: yes;">&nbsp; </span>had a<span style="mso-spacerun: yes;">&nbsp; </span>large curry and several pints of beer and was having bad indigestion. It had happened quite a lot recently. He had taken his antacid tablets but it hadn’t got better yet. Could I suggest anything? Inwardly, I thought about suggesting less beer and a Chinese instead of a curry but restrained myself.<span style="mso-spacerun: yes;">&nbsp; </span>The history certainly fitted with a digestive problem and yet….<o:p></o:p></span></span></i></div><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: Cambria;"><i><span lang="EN-US">I diverted the car to the small Border town where they lived and assessed him 15 minutes later.<span style="mso-spacerun: yes;">&nbsp; </span>Billy had time to tell me that he was a joiner, smoked</span></i><span lang="EN-US" style="mso-bidi-font-style: italic;"> 20 <i>cigarettes per day and that his father had died of a heart attack when he was 49. He then, in mid-sentence, suffered a cardiac arrest.<span style="mso-spacerun: yes;">&nbsp; </span>I ran back to the car, got the defibrillator and after two DC shocks, he came round and 30 minutes later was in hospital. He made a full recovery and went back to work after six weeks. <o:p></o:p></i></span></span></div><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US" style="mso-bidi-font-style: italic;"><span style="font-family: Verdana, sans-serif;">Without a doctor, nurse or paramedic to wield the defibrillator, Billy, self-employed joiner, son, husband, father of two primary age children would have died.<span style="mso-spacerun: yes;">&nbsp; </span>His survival relied on two individuals making the right judgement. His wife thought that his indigestion was somehow not the same as his usual Friday night indigestion.<span style="mso-spacerun: yes;">&nbsp; </span>I was alerted in something in her tone of voice, and, (I am ashamed to say rather grudgingly), visited him.<span style="mso-spacerun: yes;">&nbsp; </span>No great credit to me; all doctors have all too vivid memories of when they get it wrong, but that was a rewarding night to be a GP and to make the right judgement.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">However, the idea that judgement by doctors in individual cases is an essential part of decision making has been systematically undermined over the past twenty years, to the detriment of medicine and patient care.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">About fifteen years ago, at the start of the period when medicine began to be driven and dominated by the development and use of<span style="mso-spacerun: yes;">&nbsp; </span>evidence, in the form of guidelines or protocols,<span style="mso-spacerun: yes;">&nbsp; </span>a senor member of the profession announced at a physician’s conference:<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">‘We are now in a time when the phrase ”in my judgement” becomes unacceptable in medicine.’<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">He meant that, with the advent of good quality evidence for many conditions, there was no longer a need for doctors to make judgements on the basis of anything other than this straightforward scientific evidence. I was unhappy about this statement then and am now even more so.<span style="mso-spacerun: yes;">&nbsp; </span><o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> <span style="mso-ansi-language: EN-GB;"><o:p>&nbsp;</o:p></span></span><br /><span style="font-family: Verdana, sans-serif;"> <span style="mso-ansi-language: EN-GB;">The development of high quality evidence has been very important in improving the prognosis of many people with diseases like diabetes, coronary heart disease, asthma and many cancers, and this has contributed a lot to the increasing longevity of those of us lucky enough to live in the western world. In my professional lifetime, the outlook for those, for example, with breast cancer or heart disease has improved out of all recognition. <o:p></o:p></span></span><br /><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">However, three problems remain: <o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">The first is that in most clinical trials, the evidence for treatment is derived from a highly selected population of patients and extrapolated generally. The fact is that in many cases, these facts (the evidence) don’t tell you what to do, because, as Prof Jonathan Rees has said, the patient in front of you was not in the trial.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">The second is that the very success of these treatments now means that we have many people in the <st1:country-region w:st="on"><st1:place w:st="on">UK</st1:place></st1:country-region> who suffer from several conditions. The combination of diabetes, high blood pressure, arthritis<span style="mso-spacerun: yes;">&nbsp; </span>and obesity in elderly people for example is very common.<span style="mso-spacerun: yes;">&nbsp; </span>It has been pointed out by more than one authority that when we treat all the diseases that individuals have according to the evidence, we subject many to dangerous polypharmacy. We will also bankrupt the NHS.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><span style="font-family: Verdana, sans-serif;"> <span style="mso-ansi-language: EN-GB;">The third (from which the first two problems arise) is that we treat people as their diseases: an elderly man with angina, a middle aged woman with breast cancer. As Joanne Reeve has written (about generalism in general practice), we need an approach to the individual patient that is both biotechnical and biographical, that looks at the evidence but also at the context of the patient, situated in a family, a culture and a community. This approach also implies taking into account the patent’s autonomy, her expressed thoughts and wishes.<o:p></o:p></span></span><br /><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">Only by acknowledging the importance of judgement can we overcome these problems. Only judgement can help us assess the patient’s history and signs, assess whether this disease guideline should be considered for that patient with the disease. Judgement is needed more than ever now start discussing with older people which treatments to start, which to stop, based on what they wish for their lives—their goals, not the goal of achieving some sort of spurious physiological or biochemical normality. And finally, we need judgement to make these crucial decisions about when to say things, how much to say, how much to tell, how much to listen. This can only be based on understanding, to a greater or lesser degree, who the patient is. Martha Nussbaum called this attending to the <i style="mso-bidi-font-style: normal;">priority of the particular</i>, not the general or universal.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">However, things are getting better. Sir Michael Rawlins, Chairman of NICE, said this year that guidelines are mainly for guidance and are not diktats. Sir Peter Rubin, GMC President recently wrote to all doctors acknowledging that we make difficult decisions often with unclear evidence, which requires judgement. <o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="mso-ansi-language: EN-GB;"><span style="font-family: Verdana, sans-serif;">So how do we make these judgements?<span style="mso-spacerun: yes;">&nbsp; </span>As Gadamer and others have pointed out, we need to look for the signs of illness in the voice, the eyes and the demeanour of the patient and their relatives, not just in the purportedly objective data about her disease or illness. My story suggests that that also applies to those telling us, as clinicians, about the patient.<span style="mso-spacerun: yes;">&nbsp; </span>To do this, we need to engage our emotions as well as our intellect, make sure that our antennae are open to what is behind the patient or the relative’s words, be, in essence, human beings first and doctors second.<o:p></o:p></span></span></div><span style="font-family: Verdana, sans-serif;"> </span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;; mso-ansi-language: EN-GB; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-language: AR-SA; mso-fareast-font-family: Cambria; mso-fareast-language: EN-US;"><span style="font-family: Verdana, sans-serif;">To do this well, I think that we need practical reasoning, or what the Greeks called <i style="mso-bidi-font-style: normal;">phronesis. </i>For another day…</span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br /></div>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com0tag:blogger.com,1999:blog-8944973145355055164.post-34772044191059693552003-01-06T18:59:00.002+00:002012-03-02T17:04:34.529+00:00Luminous Words: Flourishing<br/><div class="MsoNormal" style="margin: 0cm 0cm 10pt;"><i style="mso-bidi-font-style: normal;"><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">by Val Iles<o:p></o:p></span></i></div><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">I love the idea of these luminous words and I hope I can convey some of the luminosity of the word flourishing. This is all the more important because, like so many others before it, flourishing is about to become dumbed down, diminished, made tame, in this case by its inclusion in the positive psychology market. I won't be able to do it justice, but perhaps I can enthuse you to re-explore it for yourself.<o:p></o:p></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Flourishing is one of the translations of the Aristotelian concept of eudaimonia, and in that context carries a sense of things <i style="mso-bidi-font-style: normal;">abundantly embodying the essence</i> of their thing-ness . A lark, a sunflower, a sandstone rock, a human –each of these can flourish, and in their flourishing they contribute to the world in different, essential ways. And perhaps not merely <i style="mso-bidi-font-style: normal;">a</i> human, but <i style="mso-bidi-font-style: normal;">this</i> human, this human that is me, or the human that is you, so that abundantly being me will be different from abundantly being you. <o:p></o:p></span><br /><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">For Aristotle, flourishing as a human involved (among other things) practicing the virtues: making judicious and sensitive decisions about what a courageous act, an honest behaviour, a loyal decision would be, here in <i style="mso-bidi-font-style: normal;">this</i> situation, and how it may differ there in another, using the master virtue of phronesis, or practical wisdom. So flourishing is something that can be taught and fostered ( we’ll leave aside his attitudes towards women, slaves and the ugly!).<o:p></o:p></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">At about the same time as Aristotle (two and half millennia ago) Siddartha Gautama (later termed the Buddha), drawing not so much on logic but on exquisitely detailed observations of his body/mind (perceiving the two as one),articulated a concept that is perhaps best translated as <i style="mso-bidi-font-style: normal;">awakening</i>. His fundamental insights are usually described as the four noble truths and can be (inadequately) summarised as follows:<o:p></o:p></span><br /><br /><div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Life inevitably involved dukkha. <o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt;"><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Dukkha is often translated as suffering, but has meaning across a spectrum from unsatisfactoriness to anguish. The point is that life is inevitably not the way we would ideally like it to be.<o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">The cause of dukkha is our <i style="mso-bidi-font-style: normal;">craving</i> for things to be permanently good or satisfactory, when actually:<o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18pt;"><span style="font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">nothing at all is permanent and<o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 72pt; mso-add-space: auto; mso-list: l0 level2 lfo1; text-indent: -18pt;"><span style="font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">life has to include many sadnesses and distresses or it is not life.<o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Since our craving arises from two mistaken beliefs (that we do not have everything we need to be content within this moment right now, and that there is something over there that will make us content) we can reach a point of cessation of craving by <o:p></o:p></span></div><br /><div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; text-indent: -18pt;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">fully understanding and accepting rules number 1,<span style="mso-spacerun: yes;">&nbsp; </span>2 and 3 and living a life based on that realisation. <o:p></o:p></span></div><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Is awakening another way of describing flourishing? I suggest that it is at least closely related, and indeed, with its strong advocacy of the non-dual nature of mind and body<span style="mso-spacerun: yes;">&nbsp; </span>that it relates also to the origins of the word<span style="mso-spacerun: yes;">&nbsp; </span>hale which has given us health , well and whole. <o:p></o:p></span><br /><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">We can also think more conventionally of flourishing and of the kind of nutrients that we require to flourish. And then we can use research methods to ascertain them. For humans these appear to <span style="mso-spacerun: yes;">&nbsp;</span>include, in addition to the meeting of our physical needs<span style="mso-spacerun: yes;">&nbsp; </span>many social and emotional ones<span style="mso-spacerun: yes;">&nbsp; </span>(including the need for security, for deep acceptance, for social relations, for some form of status in a group, for a sense of development, for a sense of purpose). And if we cared about flourishing we would focus our resources and our energies on ensuring that these were available to all. <o:p></o:p></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;"><span style="mso-spacerun: yes;">&nbsp; </span><o:p></o:p></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">With these three concepts of flourishing in mind, we are ready to ask the question: have we, in health care, lost our focus on flourishing? On helping people be hale, be content, be at ease? In our craving for longevity, have we forgotten that its importance is as a prerequisite for flourishing and not as an end in itself? Have we diminished our lives and those of others (and of other species) in the process?<o:p></o:p></span><br /><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">How would it be if every <i style="mso-bidi-font-style: normal;">health care interaction</i> was literally that – a two way exchange with the purpose of encouraging the flourishing of both? Surely not only the nature of the conversations would be different but the outcomes would be also. <o:p></o:p></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;"></span><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Might we teach and foster practical wisdom and an understanding of virtue ethics? Might we encourage practice in the ‘four immeasurables’ – compassion, empathetic joy, loving kindness and equanimity – based on ‘mindful’ observation of our body/mind reactions to situations? Would we fight for the opportunity for all to have the conditions in which they can flourish? <o:p></o:p></span><br /><br /><span style="font-family: &quot;Verdana&quot;,&quot;sans-serif&quot;;">Should we open a debate about the role of health care: should it be more about flourishing than longevity?<o:p></o:p></span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com0tag:blogger.com,1999:blog-8944973145355055164.post-71552541260411208042003-01-05T17:59:00.002+00:002012-01-04T18:04:28.519+00:00Luminous Words: Humility</br><i>by Jane Macnaughton</i><br /><br />‘there’s nothing so becomes a man as modest stillness and humility’<br />Shakespeare, Henry V Act 3 Sc 1.<br /><br />It is a characteristic of medicine that from the outset it incites in its recruits a deep desire to belong: outsiders wish very quickly to become insiders and to take on the characteristics that that entails. In my first few weeks as medical student, having come from the very different intellectual environment of the arts and humanities, I was shocked at the signals that were being given out to us eager and impressionable young people. We were the ‘elite’, set aside from our university peers by the intensity of our curriculum; we had to get down to learning a massive array of technical terminology ‘so the patients could not understand us’. Admittedly, times have changed in medical education, but the sense of being set apart from a wider world is initiated at university where the intellectual environment is not expansive especially in the early, most impressionable years. Unlike in philosophy or literature, there are no alternative views to put forward about the structure of brachial plexus, you just have to learn it. <br /><br />With this start, building on single-minded effort to achieve entry to medicine, and followed by hard grind to get through it, It is all too easy to become taken up with the importance of the profession and the centrality of it to one’s life. It is with some shame that I have to admit, some 25 years on, that I am only now becoming to realize just how much of an insider I became. Working intensely now with an research group from a different disciplinary perspective, it is like scales have fallen from my eyes and I find myself genuinely understanding that for many people the attainment of improved health might not in fact be a value that trumps all others in their lives. <br /><br />It was only recently too, coming fresh to preparing a session on medical professionalism for our first year medical students, that I was aware that I was once again achieving the valuable perspective of an outsider. I read through the Royal College of Physician’s report Doctors in Society: medical professionalism in a changing world (RCP, 2005) and came to the bit which lists the professional values that doctors are expected to be committed to in their day to day lives. These are: integrity, compassion, altruism, continuous improvement, excellence, partnership working with the healthcare team. This list did not feel right – these are all good things but the tone was self-congratulatory. Something was missing. I was wanting to warn my students that the important thing to remember about professionalism is that it is in the eye of the beholder: of course it matters if your colleagues think you act professionally, but it matters a lot more that your patients do. And this list seemed to be all about a doctor’s perspective and not a patient’s. What is lacked was the humility to be aware of this lack, but also the humility to see that that it needed to include humility!<br /><br />Humility is not an attribute that we normally associate with a powerful professional group like doctors, but it is at the very basis of what good doctoring is about. Good medicine at the coal face essentially involves paying close attention, setting aside preconceptions about what you as a clinician think this illness means for the patient and really listening to what it is that the patient has to say. That is the way to accurate diagnosis and to treatment that achieves the outcome that the patient wishes. Good professional leadership entails a very similar process. Unless we listen to what patients think good professional practice means, we will not be able to provide it, and in our increasingly consumer-orientated society, the gap between expectation and delivery will widen. Humility involves setting aside personal and collective professional egos and assuming an attitude that Shakespeare referred to as ‘modest stillness’. In that attentive silence we will discover how best to respond.Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com1tag:blogger.com,1999:blog-8944973145355055164.post-21199811029304808462003-01-04T13:48:00.002+00:002011-12-12T17:53:56.772+00:00Luminous Words: Wonder</br><i>by H M Evans</i><br /><br />Wonder, wondering and states of wonder abide among life’s joys. Like humour, health, music or poetry, wonder requires no justification; but unlike them – unlike even health – we do not ourselves <i>make</i> wonder: rather we stumble upon it. Wonder is a transfiguring encounter between ourselves and the world, in some aspect that we did not expect, or did not fully understand, or did not know we knew until then. While wonder lasts, the world is subtly changed, or we are changed, or both.<br /><br />If in its larger sense ‘health’ refers to a life that goes well, years to which life is added, then in that larger sense wonder upholds health. Confronting something wonderful, our sense of ourselves is suspended and we become intensely mindful of the thing wondered at – a glorious vista, the helplessness of an infant, an un-looked for explanation, an act of selfless love, a glimpse of how reality is ‘put together’, a sense of the ipseity, the ‘this-ness,’ of things. Relinquishing our sense of self, we let go of our limitations and impediments in favour of immersing ourselves fully in the experience of wondering. In wondering we are sometimes as fully and as authentically occupied with the world as it is possible for us to be.<br /><br />Even so, wonder need not be comfortable. Astonishing selflessness in others stops us short because deep down we know that morally we ourselves would invariably <i>fall</i> short. Physically, wonderful things inspire through their implacable power – Atlantic rollers thundering onto rocky shores will both mesmerise us and tear us to pieces with the same pitiless rhythm; the Moon’s filigree beauty is possible only in a lethal vacuum. The organic processes of life demand that lives end: as Dylan Thomas put it:<br /><br />The force that through the green fuse drives the flower<br />Drives my green age; that blasts the roots of trees<br />Is my destroyer.<br /><br />Even in terms of ordinary health, a glimpse into the body’s interior (familiar enough in our technological age) reminds us that our ordinary on-going experience of nothing-in-particular arises from the routine working of preposterous carnal complexity. Our existence is the existence of self-conscious meat, whatever else it is – and it is difficult to think what else could move someone to wonder, were they unmoved by this thought.<br /><br />It has been suggested that the word ‘wonder’ shares roots with the word ‘wound’. Whatever its etymological pedigree, there is something suggestive about that connection. To wonder at something is to see it outside our frame of ordinary expectations and certainties; as though these have been momentarily ripped from us, leaving us free – and vulnerable – to see the world anew, raw, un-skinned. Or it is to see through a rent, an unexpected gash in the façade of reality, to glimpse some structure (perhaps we take it to be purposeful, being the meaning-making creatures that we are) underlying the world of daily familiar life. <br /><br />In his poem ‘Ambulances’ Philip Larkin’s gaze alights briefly upon a form of existential wonder at our own mortality – a wonder that is overlain simultaneously with understanding and terror: children catch sight of the white ‘wild’ face of someone desperately ill being stretchered into the back of an ambulance before being driven off; they momentarily glimpse our – and their – finitude…<br /><br />And sense the solving emptiness<br />That lies just under all we do,<br />And for a second get it whole,<br />So permanent and blank and true.<br /><br />Wonder illuminates some of the most intense aspects of living – perhaps it also offers an alternative to rage at the ‘dying of the light.’Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com0tag:blogger.com,1999:blog-8944973145355055164.post-4215019814896234982003-01-03T17:45:00.002+00:002011-11-01T17:47:19.940+00:00Luminous Words: Presence<br/><i>by Elizabeth Barrett<br /></i><br />I chose this word because, although I know what it means, it has started to mean more to me as time goes on. <br /><br />I have done some training in facilitation and coaching over the past two years and am struck by practitioners’ habit of taking time to ‘become present’ in the room at the start of sessions. This is necessary with groups as well as individuals. <br /><br />This is certainly not a new idea and I am not claiming that it is. It is common practice in religious groups to have an opening prayer or a meditation on arrival and departure. I don’t think, however, that we pay enough attention, in the Health Service, to the idea of the need to work at being ‘present’ with purpose. <br /><br />It is difficult, as a general practitioner, to maintain the discipline of entering into the presence of every patient who comes in the door. We are obliged to control the conversation in order to collect information. We need to look at the computer to check medication and previous consultations and find a host of other information, and this can remove us from the patient’s presence for chunks of time. Each time attention is removed from the patient, the connection needs to be made afresh. <br /><br />A more general removal can be the result of being busy, anxious or having unwanted interruptions. However, I suspect that the most powerful block to being present with patients is the set of assumptions we have before we even meet. These are particularly powerful because they are difficult to recognize and acknowledge. The most bitter dissatisfaction is sometimes the result of a clinician inadvertently revealing their internal assumptions about the patient and, thereby, blocking their own presence with that patient. <br /><br />Having worked with the PCT for a couple of years, I am aware of the unsatisfactory nature of many meetings, and how hard it can be to have real conversations with others. There are hundreds of reasons for lack of meaningful presence in large organizations, but the NHS rarely allows time for reflection on such soft matters, despite the huge waste of resources involved in unhelpful or dysfunctional meetings. <br /><br />I used to be a put out when patients left the room saying ‘Thank you for your time, doctor’. I thought it probably meant I hadn’t done anything useful, but they were acknowledging the time I had wasted on them. While I still have a slight twinge of self-doubt at this remark, I now hope that it sometimes denotes an acknowledgement of presence.Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com1tag:blogger.com,1999:blog-8944973145355055164.post-5907360881342199492003-01-02T15:15:00.004+00:002011-10-16T15:23:02.791+01:00Luminous Words: Death<br/><i>by Andrew Edgar</i><br /><br />Death is a style icon. <br /><br />In the middle ages, the memento mori carried a significance. The tombs of medieval bishops and abbots might have two effigies. The upper one would be the man as he was in life, resting in full ecclesiastical regalia. Beneath lay the carving of a rotting corpse, still not quite a skeleton. The spectator is reminded, not simply of death, but of the inexorable decomposition into nothingness of one’s mortal remains. Renaissance paintings of St Jerome in his study frequently showed a melancholy scholar tapping his fingers on a skull. The scholar’s genius, for all its universal significance and endurance, threatened to crumble before the conundrum of personal morality.<br /><br />As the philosopher Heidegger noticed, humans are unique, not in that we are mortal, but in that we know we are mortal. Yet modern culture dedicates itself to denying that mortality. We live, as it were, in a ‘never say die’ culture. We will say ‘pass on’, we will describe someone as ‘late’ or even (and especially in the case of parrots) ‘ex-’. We may say ‘kick the bucket’, ‘wring up the final curtain’ and ‘join the choir invisible’. But we never ‘die’. We of course no longer stroll on a Sunday afternoon around the local cemetery as once we did, and thanks to the triumphs of modern medicine we encounter death infrequently in our everyday lives, except when it happens to distant people on the television news.<br /><br />The visual equivalent of this is perhaps the recurrent of the motif of a skull in Damien Hirst’s work, through the spin pictures and culminating in the diamond encrusted ‘For the love of God’. But this is the memento mori reduced to a trade mark, as empty of significance as Bass’ red triangle. The image lacks the threat of decay and corruption familiar to the medieval and Renaissance mind. It blandly points to something that we cannot quite grasp. As such it remains comfortingly this side of mortality, leaving us undisturbed. Death is a play-thing that need not disturb life.<br /><br />Death was nineteenth century medicine’s final enemy. Surgery and the pharmacopeia would defeat it, and in a peculiar way they have. Death has been hustled away from our ordinary lives, and enclosed, along with the lepers and lunatics, in its own asylums. The problem is of course that we are then left drastically ill-equipped to deal with death on the odd, but inevitable occasions, when it is let out. <br /><br />Not every medical decision is a matter of life and death. Many now are calculations of the quality of lives that will run their natural course regardless. But, when life and death decisions have to be made – and they may be made not simply in the dramatic interventions of surgeon and the A7E team, but also as the manager allocates and re-allocates inevitably scarce resources – the trade-off no longer quite makes sense. We have lost the cultural resources that are required to think through death, either as an evil or as a good. The medical profession dogmatically assumes that it is an evil, and politicians were happy to rank hospitals according to their mortality rates. Yet, conversely, as a trade-marked commodity it is available as a personal consumer choice (in Swiss euthanasia clinics, if not elsewhere).<br /><br />The superficiality of our culture’s attitude to death serves us badly, be we patients or medical professionals. In the trade-off between life and death, it is not simply that death makes no sense, for nor does life, if it is no more than the absence of something that we cannot grasp anyway. Perhaps a reproduction of a St Jerome, or a photograph of an abbot’s tomb from Tewkesbury Abbey, should be in every doctor’s and health care manager’s office, just as a start.Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com1tag:blogger.com,1999:blog-8944973145355055164.post-34551848424345803792003-01-01T18:02:00.006+00:002011-09-19T18:17:40.631+01:00Luminous Words: Vocation<br/><span style="font-family: verdana;"><em>by Stephen Pattison</em></span><br /><br /><span style="font-family: verdana;">Vocation and profession are both words that come out of religious life. Your vocation was your call from God to separate yourself off and pursue a certain ‘higher’ way of life and service; your profession was your public commitment to that way of living, perhaps accompanied by promises or vows like the Hippocratic oath.<br /><br />Like Tony Blair, many of us ‘don’t do God’ in public these days. We worry about the capacity of formal religion to oppress both groups and individuals. And who in the NHS really regrets the passing of veils and long robes for nurses, some of whom within living memory were still called ‘Sister’?<br /><br />We might be able live without the restricted life, the funny hats and the religious titles, but can we really fully live without the idea of vocation? Even if you don’t believe in God and are indifferent to religion, might it still be helpful to see yourself as engaged in work that transcends self-interest, job descriptions and narrow contractual obligations? Someone who is in a sense ‘called’ to follow a particular path that will involve the whole of yourself, not just the bits that are specified as essential skills and competences.<br /><br />Vocation adds something to labour and to work. Part of what it adds is apparently external importance, dignity and personal and moral purpose – motivation and ethical imperative, if you like. I don’t just do this for money, I do it because it is important to society, important to individuals, important to my own sense of having a valued and valuable life. That is why I don’t stop working when the shift ends or when I have fulfilled to the letter the tasks, terms and conditions of my employment. And I don’t necessarily want someone to just give me more money for what I have done over the odds; I want them to recognise that my work and identity as a professional has an intrinsic value to myself and others and that it is worthy of the highest respect. Something that I treasure beyond what I am paid because it is part of my identity and part of what makes me feel that my whole life as a human being has worth. When people put a price on it, they put a price on me and make me a wage slave, not a professional.<br /><br />Vocation, the sense that there is something I must do if I am to live fully, is value added to human life and labour. It’s free, it cannot be coerced, and it’s compelling well beyond the bounds of religion – consider the nerds at Microsoft who work all night for the joy of solving a problem. Can we afford to do without it in health care? Would we want to receive and deliver the kind of health care that has no room for vocation?</span><br /><br /><span style="font-family: verdana;"><em>by Val Iles</em><br /><br />Why does ‘vocation’ seem an old fashioned idea? One out of tune with today?<br /><br />The preoccupation of the moment is economic growth. A growth fuelled by (in the West) a desire to, in the words of professor Tim Jackson: ‘spend money we don’t have, on things we don’t need, to impress people we don’t care about’. As he points out, we will need in future, if we are not to make unsustainable demands of our planet, to allow growth only where it does the greatest work, that is in the poorest countries of the world. That leaves the West either to live without growth or (if this is possible) to decouple financial growth from material growth. Either of these scenarios mean that we will need to pursue an ‘alternative hedonism’, that we will have to consider how we spend our time rather than our money, or that we spend our money on our time. Our time – us, our lives - could become important again, not merely a vehicle for the distractions of shopping and media, not merely a means of supporting our fragile and confused egos.<br /><br />When we look behind our confusion we find a compassion that we are being taught not to trust. With the mantra of ‘self interest’ we are corrupting ourselves and our patients. Without the stigma attached through the ages to acts of selfishness and lack of concern for others we treat patients as ‘grown ups’ at times in their lives when their future expectations are turned upside down or they bear long term discomforts that require fortitude and courage. This allows us to behave entirely rationally, to offer care that is at heart transactional rather than covenantal, to care for them and not about them.<br /><br />What we fail to recognise is that it is not only they who lose an important dimension from their lives. We too are diminished as we cut ourselves off from the challenge and the rewards of loving our neighbours as well as ourselves.<br /><br />Down the millennia we’ve been encouraged to do both – care for others AND for ourselves. Ours is the first to laud the latter and describe the former in disparaging terms (co-dependency, utility).<br /><br />Let us return to the road of sanity and restore a pride in a sense of vocation.</span>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com1tag:blogger.com,1999:blog-8944973145355055164.post-34606574394558157812002-01-07T20:14:00.001+00:002013-03-18T01:24:56.994+00:00Who are the Think About Health Network?<span style="font-family: verdana; font-size: 100%;">Think About Health is an interdisciplinary network of professionals, users and academics that aims to improve the ‘intellectual plumbing’ of the NHS as well participants’ own thinking and practice.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;">A full list of members can be found <a href="http://www.thinkabouthealth.net/2008/07/members.html">here</a>.</span><br /><span style="font-size: 100%;"><span style="font-family: verdana;"><br /></span></span><span style="font-family: verdana; font-size: 100%; font-weight: bold;">Background and Activities</span><br /><span style="font-size: 100%;"><span style="font-family: verdana;"><b><br /></b></span></span><span style="font-family: verdana; font-size: 100%;">The creation of the Think About Health network was first proposed at a meeting in Cardiff in August 2007. This meeting built on the foundations laid by the Report on the Nuffield Trust Seminar </span><span style="font-size: 100%;"><a href="http://www.thinkabouthealth.net/2008/07/report-on-nuffield-trust-seminar-health.html" style="font-family: verdana;">“Health Care and the Public Interest”</a></span><span style="font-family: verdana; font-size: 100%;">, which had concluded that:</span><span style="font-size: 100%;"><br /></span><span style="color: black; font-family: verdana; font-size: 100%; font-style: italic;">“it was vital to begin to establish open public spaces for informed and critical thought and discussion about fundamental aims, values and directions in a publicly owned and run service”</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;">At the Cardiff meeting it was decided that a forum was needed to allow all parties interested in UK health policy and its direction to meet and discuss their concerns, with a view to changing things for the better.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;"><span style="font-weight: bold;"><br /></span></span><br /><span style="font-family: verdana; font-size: 100%;"><span style="font-weight: bold;">What do we do?</span><br /><br />Following our successful inaugural conference, <a href="http://www.thinkabouthealth.net/2008/07/think-about-health-2008-conference.html">“On the 'Remoralisation' of Health Policy”</a>, held in Manchester in April 2008, the network was formally established in Birmingham in January 2009. The minutes of the founding meeting can be found </span><span style="font-size: 100%;"><a href="http://www.thinkabouthealth.net/2008/07/think-about-health-network-founding.html" style="font-family: verdana;">here</a></span><span style="font-family: verdana; font-size: 100%;">, and the network constitution </span><span style="font-size: 100%;"><a href="http://www.thinkabouthealth.net/2009/01/constitution-for-think-about-health.html" style="font-family: verdana;">here</a></span><span style="font-family: verdana; font-size: 100%;">.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;">The network continues to meet together to think together about the issues and problems arising in the contemporary NHS to derive insights and understandings that are stimulating and valuable for theoreticians, practitioners and users.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;">Click <a href="http://www.thinkabouthealth.net/search/label/Upcoming%20Events">here</a> to find out about upcoming events, or <a href="http://www.thinkabouthealth.net/search/label/Previous%20Events">here</a> to find out about some of the events that we have organised already.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%; font-weight: bold;"><br /></span><br /><span style="font-family: verdana; font-size: 100%; font-weight: bold;">Who can become a member or associate?</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;"><br /></span><br /><span style="font-family: verdana; font-size: 100%;">Think About Health has members and mailing list associates who are service users, nurses, GPs, physicians, lawyers, philosophers, managers and others.<br /><br />We welcome all those who are interested in thinking about health – regardless of background, profession or discipline – as members or mailing list associates.</span><span style="font-size: 100%;"><br /></span><span style="font-family: verdana; font-size: 100%;">Click </span><span style="font-size: 100%;"><a href="http://www.thinkabouthealth.net/2008/05/become-member.html" style="font-family: verdana;">here</a></span><span style="font-family: verdana; font-size: 100%;"> to find out more about the benefits of membership.</span>Simon Walthonoreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-53834304410973658662002-01-06T08:49:00.004+00:002013-03-18T01:32:24.124+00:00Interested in Joining?<span style="font-family: verdana; font-size: 100%;"><br />Think About Health has members and mailing list associates who are service users, nurses, GPs, physicians, lawyers, philosophers, managers and others.<br /><br />We welcome all those who are interested in thinking about health – regardless of background, profession or discipline – as members.<br /><br />Membership costs just £10 a year and entitles you to a discount on conference fees as well as a subscription to the electronic newsletter.<br /><br />To join, please complete the <a href="https://docs.google.com/a/thinkabouthealth.net/leaf?id=0B1Ni-H3C2ViTZDQxYzBjYmMtMjY0Yy00OTI4LWJmN2YtNjg4MDk3M2Q5Njhm&amp;sort=name&amp;layout=list&amp;num=50">membership form</a> and return it to the indicated address.<br /><br />If you would like to be kept informed of events organised by the Network,&nbsp;</span><span style="font-family: verdana;">please e-mail our Treasurer, Grace Edgar, &nbsp;grace.edgar@hotmail.com.</span><span style="font-family: verdana; font-size: 100%;"></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-65131804948197105182002-01-05T05:33:00.004+00:002013-04-09T14:59:35.807+01:00Contact us<span style="font-family: trebuchet ms;"></span><span style="font-family: verdana;"><br /><span style="font-size: 100%;">If you have any comments, queries or feedback about this website or the Network as a whole, please get in touch.</span><br /><br /><span style="font-size: 100%;">For general queries regarding the Network, its website and/or Upcoming Events; if you'd like to share details of upcoming events that you think may be of interest to our members; or if you are a member or associate who'd like to let others know about your recent publications, contact Simon Waltho at&nbsp;</span><a href="mailto:grace.edgar@hotmail.com">grace.edgar@hotmail.com</a><br /><br /><span style="font-size: 100%;">For more information about becoming a member, or joining the mailing list, click </span><a href="http://www.thinkabouthealth.net/2008/05/become-member.html" style="font-size: 100%;">here</a><span style="font-size: 100%;"> or contact </span><a href="mailto:membership@thinkabouthealth.net" style="font-size: 100%;">membership@thinkabouthealth.net</a></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-61958920773904830192002-01-03T20:32:00.015+00:002013-04-17T00:47:30.281+01:00Executive Committee & Members' Testimonials<br /><span style="font-family: Arial, Helvetica, sans-serif;"></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><b>Executive Committee</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br /><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;"></span></div><a href="http://2.bp.blogspot.com/-sDvZHWb8Ipk/UW23-BpK5XI/AAAAAAAAAEI/6AbW_7Gzqnc/s1600/edgar.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-sDvZHWb8Ipk/UW23-BpK5XI/AAAAAAAAAEI/6AbW_7Gzqnc/s1600/edgar.png" /></a><span style="font-family: Arial, Helvetica, sans-serif;">Convenor: Dr Andrew Edgar</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Director of the Centre for Applied Ethics,</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Cardiff University</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Treasurer: Mrs Grace Edgar</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Statistician, Office of National Statistics</span><br /><br /><br /><div class="separator" style="clear: both; text-align: center;"></div><a href="http://2.bp.blogspot.com/-wpbEfNxtLq0/UW24Jzd3KWI/AAAAAAAAAEQ/HMo5PgFowd0/s1600/pattinson.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-wpbEfNxtLq0/UW24Jzd3KWI/AAAAAAAAAEQ/HMo5PgFowd0/s1600/pattinson.png" /></a><span style="font-family: Arial, Helvetica, sans-serif;"></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></span><span style="font-family: Arial, Helvetica, sans-serif;">Secretary: Professor Stephen Pattison</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">HG Wood Professor of Theology</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">University of Birmingham</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Members:</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"></span><br /><a href="http://2.bp.blogspot.com/-vySvXp0VVIE/UW264nZYWPI/AAAAAAAAAFA/ar8FUhl9AcE/s1600/Iles.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://2.bp.blogspot.com/-vySvXp0VVIE/UW264nZYWPI/AAAAAAAAAFA/ar8FUhl9AcE/s1600/Iles.png" /></a><span style="font-family: Arial, Helvetica, sans-serif;">Ms Valerie Iles</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Director, Really Learning Health Care Consultancy</span><br /><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif;"></span></div><br /><span style="font-family: Arial, Helvetica, sans-serif;">Professor Stephen Tyreman</span><br /><a href="http://1.bp.blogspot.com/-KsVYOimfq1w/UW26DE_818I/AAAAAAAAAE4/rXA0I5YH6QA/s1600/tyreman.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://1.bp.blogspot.com/-KsVYOimfq1w/UW26DE_818I/AAAAAAAAAE4/rXA0I5YH6QA/s1600/tyreman.png" /></a><span style="font-family: Arial, Helvetica, sans-serif;">British School of Osteopathy</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Dr Frank Barrett</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">General Practitioner</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Dr Joao Calinas</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">General Practitioner, Nottinghamshire</span><br /><br /><br /><span style="font-family: verdana;"></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-40263049727153258812002-01-03T06:00:00.000+00:002010-12-10T14:25:41.420+00:00Constitution for the Think About Health Network<span style="font-family:trebuchet ms;">Article I: Name</span><br /><br /><span style="font-family:trebuchet ms;">1. Think About Health</span><br /><br /><span style="font-family:trebuchet ms;"><br />Article II: Aim</span><br /><br /><span style="font-family:trebuchet ms;">1. To promote disciplined reflection upon health care provision, and to provide a forum for discussion between health care practitioners, service users, policy-makers, the general public, academics and any other interested parties about the nature, purposes and justice of health care provision in the UK.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article III: Membership</span><br /><br /><span style="font-family:trebuchet ms;">1. There shall be two types of membership: Standard and Student/Retired/Unwaged.</span><br /><br /><span style="font-family:trebuchet ms;">2. 'Anyone interested in adding breadth and depth to discussions about the nature, function and future of health care services in the UK shall be eligible for membership'.</span><br /><br /><span style="font-family:trebuchet ms;">3. Any full-time or part-time college or university student pursuing study in an undergraduate or graduate degree-granting programme shall be eligible for Student Membership. The rights and duties of such members shall be identical to those of other members.</span><br /><br /><span style="font-family:trebuchet ms;">4. Membership of all types shall become effective upon receipt of applicable dues by the Treasurer and Membership Secretary.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article IV: Officers</span><br /><br /><span style="font-family:trebuchet ms;">1. </span><br /><span style="font-family:trebuchet ms;">(a) The Officers of the Association shall be a Chair, a Vice-Chair, a Secretary, a Treasurer and Membership Secretary, a Publicity Officer, a Website Manager, and three Committee Members. </span><br /><br /><span style="font-family:trebuchet ms;">(b) A Chair shall be elected for a three-year term and shall become the Chair at the conclusion of the Annual General Meeting in the calendar year of the election.</span><br /><br /><span style="font-family:trebuchet ms;">(c) A Vice-Chair shall be elected for a three-year term and shall become the Vice-Chair at the conclusion of the Annual General Meeting in the calendar year of the election.</span><br /><br /><span style="font-family:trebuchet ms;">(d) A Secretary shall be elected for a three-year term and shall become the Secretary at the conclusion of the Annual General Meeting in the calendar year of the election. </span><br /><br /><span style="font-family:trebuchet ms;">(e) A Treasurer and Membership Secretary shall be elected for a three-year term and shall become the Treasurer and Membership Secretary at the conclusion of the Annual General Meeting in the calendar year of the election.</span><br /><br /><span style="font-family:trebuchet ms;">(f) A Publicity Officer shall be elected for a three–year term and shall become the Publicity Officer at the conclusion of the Annual General Meeting in the calendar year of the election.</span><br /><br /><span style="font-family:trebuchet ms;">(g) A Website Manager shall be elected for a three-year term and shall become the Website Manager at the conclusion of the Annual General Meeting in the calendar year of the election.</span><br /><br /><span style="font-family:trebuchet ms;">(h) Three Committee Members shall be elected for a three-year term and shall become Committee Members at the conclusion of the Annual General Meeting in the calendar of the election. </span><br /><br /><span style="font-family:trebuchet ms;">(i) No member of the Association may concurrently nominate for, nor may concurrently occupy more than one position on the Executive Committee (i.e., more than one Officer’s position). </span><br /><br /><span style="font-family:trebuchet ms;">(j) Terms of office for Association Officers shall begin at the conclusion of the Annual General Meeting in the calendar year of their election. </span><br /><br /><span style="font-family:trebuchet ms;">2. The Chair shall </span><br /><br /><span style="font-family:trebuchet ms;">assume the executive responsibility of the Association;</span><br /><br /><span style="font-family:trebuchet ms;">enforce the Constitution of the Association;</span><br /><br /><span style="font-family:trebuchet ms;">schedule and preside over meetings of the Executive Committee;</span><br /><br /><span style="font-family:trebuchet ms;">schedule and preside over the Annual General Meeting;</span><br /><br /><span style="font-family:trebuchet ms;">prepare the agenda for meetings of the Executive Committee and for the Annual General Meeting;</span><br /><br /><span style="font-family:trebuchet ms;">solicit agenda items from the membership for Executive Committee meetings and for the Annual General Meeting;</span><br /><br /><span style="font-family:trebuchet ms;">liaise with members of the Association; most notably, with members of the Executive Committee;</span><br /><br /><span style="font-family:trebuchet ms;">prepare and deliver the Chair’s Address at the Annual Meeting; and</span><br /><br /><span style="font-family:trebuchet ms;">represent the Association to the broader public.</span><br /><br /><span style="font-family:trebuchet ms;">3. The Vice-Chair shall</span><br /><br /><span style="font-family:trebuchet ms;">aid the Chair in his or her duties or responsibilities as and when requested by the Chair; and</span><br /><br /><span style="font-family:trebuchet ms;">assume the duties of the Chair if necessary.</span><br /><br /><span style="font-family:trebuchet ms;">4. The Secretary shall </span><br /><br /><span style="font-family:trebuchet ms;">record, retain, and appropriately distribute Minutes of all Executive Committee meetings and the Annual General Meeting;</span><br /><br /><span style="font-family:trebuchet ms;">administer the elections for all members (including officers) of the Executive Committee</span><br /><br /><span style="font-family:trebuchet ms;">administer the elections for all proposed constitutional amendments/revisions; and</span><br /><br /><span style="font-family:trebuchet ms;">make an annual report to the Executive Committee and to the Annual General Meeting.</span><br /><br /><span style="font-family:trebuchet ms;">5. The Treasurer and Membership Secretary shall</span><br /><br /><span style="font-family:trebuchet ms;">keep current contact information for all Association members;</span><br /><br /><span style="font-family:trebuchet ms;">administer all membership transactions and collections of dues;</span><br /><br /><span style="font-family:trebuchet ms;">keep accurate records of the fiscal resources of the Association;</span><br /><br /><span style="font-family:trebuchet ms;">supervise and process all expenditures; and</span><br /><br /><span style="font-family:trebuchet ms;">make an annual report to the Executive Committee and to the Annual General Meeting concerning the financial status of the Association and concerning new and continuing members of the Association.</span><br /><br /><span style="font-family:trebuchet ms;">6. The Publicity Officer shall</span><br /><br /><span style="font-family:trebuchet ms;">be responsible for compiling and distributing at least one annual report</span><br /><br /><span style="font-family:trebuchet ms;">make an annual report to the Executive Committee and to the Annual General Meeting in respect to the state of the Newsletter;</span><br /><br /><span style="font-family:trebuchet ms;">liaise with members of the Association; most notably, with members of the Executive Committee, in order to ensure that the Newsletter functions as an effective medium of communication in respect to the affairs of the Association; and</span><br /><br /><span style="font-family:trebuchet ms;">liaise with the Website Manager in order to develop effective ways to promote and market the Association.</span><br /><br /><span style="font-family:trebuchet ms;">7. The Website Manager shall</span><br /><br /><span style="font-family:trebuchet ms;">design and maintain the society/association/network web site;</span><br /><br /><span style="font-family:trebuchet ms;">liaise with members of the Association, most notably, with members of the Executive Committee in order to ensure that the website functions as an effective medium of communication about the Association’s business for Association members and the broader public; </span><br /><br /><span style="font-family:trebuchet ms;">liaise with the Publicity Officer in order to develop effective ways to promote and market the Association; and</span><br /><br /><span style="font-family:trebuchet ms;">make an annual report to the Executive Committee and to the Annual General Meeting in respect to the state of the website.</span><br /><br /><span style="font-family:trebuchet ms;">8. The Committee Members shall </span><br /><br /><span style="font-family:trebuchet ms;">aid any of the other members of the Executive Committee in their duties or responsibilities as and when requested.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article V: The Executive Committee</span><br /><br /><span style="font-family:trebuchet ms;">1. Except as otherwise provided by this Constitution, the management of all Association affairs shall be vested in the Executive Committee.</span><br /><br /><span style="font-family:trebuchet ms;">2. The Executive Committee shall consist of the Officers of the Association.</span><br /><br /><span style="font-family:trebuchet ms;">3. Four members of the Executive Committee shall constitute a quorum.</span><br /><br /><span style="font-family:trebuchet ms;">4. Except as otherwise provided by this constitution, decisions of the Executive</span> <span style="font-family:trebuchet ms;">Committee shall be taken by majority vote of its members present and voting. All members of the Committee shall hold full voting rights except the presiding officer, who shall only vote in the event of a tie. In actions taken by the Committee with special respect to one of its members, that member shall not vote.</span><br /><br /><span style="font-family:trebuchet ms;">5. The Executive Committee shall act on all constitutionally mandated recommendations for appointment and other operations brought to it.</span><br /><br /><span style="font-family:trebuchet ms;">6. The Executive Committee shall have power to co-opt for specific purpose/limited time.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article VI: Committees</span><br /><br /><span style="font-family:trebuchet ms;">1. Committees shall be appointed by the Chair as required by the work of the</span> <span style="font-family:trebuchet ms;">Association.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article VII: Meetings</span><br /><br /><span style="font-family:trebuchet ms;">1. There shall be an Annual Meeting of the Association held at a time and place</span> <span style="font-family:trebuchet ms;">designated by the Executive Committee. This meeting shall consist of learned sessions and an Annual General Meeting. The agenda for the Annual General Meeting, which concerns the logistic affairs of the Association, shall be arranged by the Chair, who shall preside over the Meeting.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article VIII: Elections</span><br /><br /><span style="font-family:trebuchet ms;">1. All elections shall be conducted electronically and confirmed at the Annual General Meeting. In the case of two or more nominated candidates for a position, those candidates shall be presented to the membership for election.</span><br /><br /><span style="font-family:trebuchet ms;">2. The results of these elections shall be publicly announced in advance of the Annual General Meeting at which they are to be confirmed.</span><br /><br /><span style="font-family:trebuchet ms;"><br />Article IX: Dues and Finance</span><br /><br /><span style="font-family:trebuchet ms;">1. The Executive Committee shall recommend the level of annual dues to the assembled membership at the Annual General Meeting. The membership shall then set this level by majority vote of those present and voting.</span><br /><br /><span style="font-family:trebuchet ms;">2. Student/Retired/Unwaged Members shall pay dues reduced as against those required of Standard Members.</span><br /><br /><span style="font-family:trebuchet ms;">3. The fiscal year of the Association shall begin on January 1st and shall end on</span> <span style="font-family:trebuchet ms;">December 31st of the same year. All dues shall be therefore payable annually on or by January 1st.</span><br /><br /><span style="font-family:trebuchet ms;">4. Members who have been excluded from the Association for non-payment of dues shall be duly reinstated upon receipt of full payment (of outstanding dues) by the Treasurer and Membership Secretary, if such payment is received during the year in which the member(s) was(were) excluded.</span><br /><br /><span style="font-family:trebuchet ms;">5. Although the Treasurer and Membership Secretary cares for all current financial documents of the Association, executes all financial transactions for the Association, and prepares all budget proposals of the Association, the final authority over all financial/budgetary matters is vested in the Executive Committee.</span><br /><br /><br /><span style="font-family:trebuchet ms;">Article X: Amendments</span><br /><br /><span style="font-family:trebuchet ms;">1. Either the Executive Committee or any member of the Association in good standing may propose amendments/revisions to the Constitution by presenting their proposals to the Secretary with reasonable notice prior to any Annual Meeting. </span><br /><br /><span style="font-family:trebuchet ms;">2. Such proposals shall be then considered by the assembled membership at the Meeting. If approved by a two-thirds majority of those present and voting at the Meeting, the proposed amendments/revisions shall become effective with effect from the date of the Meeting.<br /><br /></span><span style="font-family:trebuchet ms;"><br />(AGREED 14TH JAN 2009)<br /></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-27251642401730915632002-01-02T19:40:00.000+00:002010-12-10T14:26:11.732+00:00Founding Meeting Minutes<span style="font-family:trebuchet ms;"><span style="FONT-STYLE: italic">14th January 2009</span></span><br /><br /><span style="FONT-STYLE: italic;font-family:trebuchet ms;" >The Meeting took place in Elmfield House, Univ. of Birmingham, Bristol Road, Birmingham</span><br /><br /><span style="font-family:trebuchet ms;">Andrew Edgar took the chair as convenor of the Constitution sub-group.</span><br /><br /><span style="font-family:trebuchet ms;">Present: Elizabeth Barrett, GP, Warsop, Notts, Hazel Biggs, Medical law academic, Lancaster Uni, John Coggon, Health care law, Manchester Uni, J Calinas, GP, Nottingham, Angus Clarke, Consultant geneticist, Cardiff, Andrew Edgar, Philosophy, Cardiff Uni, Thomas Hayes, Health care law, Cardiff Uni, Iona Heath, GP, London, Valerie Iles, Management academic, London, Lynne Lawrance, Microbiology academic, UWE Bristol, Yan Yan Leung, Medical law and ethics, London Uni, Mairi Levitt, Ethics academic, Lancaster Uni, Sheelagh McGuiness, Health care ethics and law, Keele Uni, Julia McKeown, Project manager, Birmingham, Jonathan Montgomery, PCT chair and law academic, Southampton, Peter Nolan, Mental health nursing, Staffordshire Uni, Stephen Pattison, Theologian, Birmingham Uni, Athar Yawar, Lancet editor, London, Katharine Young, Clinical standards facilitator, RCP, London</span><br /><br /><span style="font-family:trebuchet ms;">Apologies: David Badcott, Tom Heller, Derek Sellman, Kieran Sweeney</span><br /><br /><span style="FONT-WEIGHT: bold;font-family:trebuchet ms;" >Constitution</span><br /><br /><span style="font-family:trebuchet ms;">A draft constitution for the Think About Health Network was presented to the gathering by Andrew Edgar. </span><br /><br /><span style="font-family:trebuchet ms;">The constitution was agreed upon unanimously, establishing the Think About Health Network as an association. </span><br /><br /><span style="font-family:trebuchet ms;">Andrew Edgar nominated Stephen Pattison to be Chair and this was unanimously agreed.</span><br /><br /><span style="FONT-WEIGHT: bold;font-family:trebuchet ms;" >Officers </span><br /><br /><span style="font-family:trebuchet ms;">The following Officers of the Association were appointed by unanimous agreement:</span><br /><span style="font-family:trebuchet ms;">• Treasurer and Membership Secretary – J. Calinas</span><br /><span style="font-family:trebuchet ms;">• Secretary and Website Manager – Yan Yan Leung</span><br /><br /><span style="font-family:trebuchet ms;">It was agreed to suspend further appointments of officers until the Network met at its next conference in Sept 09.</span><br /><br /><span style="FONT-WEIGHT: bold;font-family:trebuchet ms;" >Money matters</span><br /><br /><span style="font-family:trebuchet ms;">The treasurer was instructed to open a bank account for the association.</span><br /><br /><span style="font-family:trebuchet ms;">The membership fee was set at £10 pa and all those who had paid £20 to attend the day event on the NHS constitution were deemed to have paid the current subscription. Others may join by paying a £10 annual fee.</span><br /><br /><span style="FONT-WEIGHT: bold;font-family:trebuchet ms;" >Conference organising committee</span><br /><br /><span style="font-family:trebuchet ms;">An organising committee was appointed to organise the conference and AGM on Sept 17-18th 2009: John Coggon(?), Valerie Iles (corresponding member) , Sheelagh McGuinness, Jonathan Montgomery (virtual member), Derek Sellman, Stephen Pattison, J Calinas, Yan Yan Leung.</span><br /><br /><span style="font-family:trebuchet ms;">The theme of the September conference was discussed. It was resolved that the theme should be something along the line of: Changing Roles and Relationships: Moral Integrity in Health Care. It was agreed that it was very important that both academics and practitioners should be able to participate fully in this event and Val Iles offered to help structure the process.</span><br /><br /><span style="FONT-WEIGHT: bold;font-family:trebuchet ms;" >Report to members</span><br /><br /><span style="font-family:trebuchet ms;">It was resolved that J Calinas would collate a report out of the proceedings on the day about the NHS constitution and this would be circulated to members and put on the Think About Health Website. It was also resolved to circulate the link for the Think About Health website to members: <a href="http://thinkabouthealth.blogspot.com/">http://thinkabouthealth.blogspot.com/</a></span><br /><br /><span style="font-family:trebuchet ms;">Further informal notes on publication and conference plans are appended, together with the agreed constitution. </span><br /><br /><span style="font-family:trebuchet ms;">It was agreed that the constitution and minutes should be forwarded to members and the mailing list along with a report of the day and a request from J Calinas for membership subscriptions.</span><br /><br /><span style="font-family:trebuchet ms;">There being no further business the Chair thanked everyone for attending and the meeting was adjourned. An AGM to ratify the constitution will be held at the September conference.<br /><br /></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-61881204908823683422002-01-01T00:00:00.001+00:002010-12-10T14:28:38.318+00:00Report on Nuffield Trust Seminar: Health Care and the Public Interest<span style="font-family:trebuchet ms;font-size:100%;"><span style="FONT-STYLE: italic">London, 6th July 2006</span><br /><br /><span style="FONT-STYLE: italic">Martyn Evans, Iona Heath, Stephen Pattison</span><br /><br />The Nuffield Trust generously supported a seminar for twenty participants on ‘Health Care and the Public Interest’ at its London Headquarters in July 2006. Participants included health care providers, clinicians, policy makers, patient representatives, medical journalists, and academics from a variety of backgrounds including philosophy, theology and planning. We are grateful to the Trust for supporting the seminar and to the people who attended and contributed so fully and freely.<br /><br /><span style="FONT-STYLE: italic">Background </span><br /><br />In his 1821 essay ‘On living to oneself’, William Hazlitt wrote:<br /><br /></span><br /><blockquote><span style="font-family:trebuchet ms;font-size:100%;">we may safely say that the public is the dupe of public opinion, not its parent.</span></blockquote><span style="font-family:trebuchet ms;font-size:100%;"><br />Kierkegaard was rather more vituperative along similar lines and is quoted by Philip Roth in his novel ‘I Married a Communist’:<br /><br /></span><br /><blockquote><span style="font-family:trebuchet ms;font-size:100%;">He wanted me to listen to him read what Kierkegaard ... had already surmised in backwater Copenhagen a hundred years ago about “the people” - whom Kierkegaard called “the public”, the correct name ... for that abstraction, that “monstrous abstraction”, that “all-embracing something which is nothing”, that “monstrous nothing”, as Kierkegaard wrote, that “abstracted and deserted void which is everything and nothing”</span></blockquote><span style="font-family:trebuchet ms;font-size:100%;"><br />To a considerable extent, this seminar arose out of the suspicion that Hazlitt’s insight might reflect an enduring truth, and that Kierkegaard’s ‘monstrous nothing’ continues to be invoked as part of the exercise of power. The suspicion arose from a sense that in the context of a contemporary unrelenting ‘policy tsunami’ there appeared to be little opportunity for people properly to assess and assent to the directions that British public health care policy is taking.<br /><br />The seminar set out to explore this suspicion via four questions:<br /><br />1. Do we have effective mechanisms for representing the public interest and aspiration effectively in formulating radical changes in health care policy and practice?<br /><br />2. To what extent do policy makers think about ethics and values in the course of designing and implementing policies, and in what terms?<br /><br />3. Who writes health care policies and how is the ‘public interest’ mediated to and through them? Do policy makers have regard to moral and teleological issues (ie to the overall direction and big picture) pertaining to the future of health care provision and service?<br /><br />4. How might citizens be more effectively engaged in formulating policy and practice in a practically and ethically informed way?<br /><br />In brief, the consensual answers to these questions were broadly as follows.<br /><br />1. There appear to be no clear, widely participated in, effective methods for representing public interest, particularly at the strategic level of NHS planning. While there are consultation processes, and there may be some checks and balances, especially in Wales and Scotland, this is essentially reactive to what the NHS is doing and it prescinds from looking at guiding principles and visions. It is rumoured that Alan Milburn, when Secretary of State for Health, wrote the current NHS 10 year plan over a weekend with 2 officials. Whether or not this is true, it is paradigmatic of the very pragmatic way in which ideas and fundamental directions are determined. No-one really looks proactively at the bigger picture or thinks about what health is or where we are going. It is difficult, given the plurality of the public, to see how this situation might be different. Our hypothesis that there is little attempt to look at the big picture and think about fundamental ends, ideologies and structures seems, sadly, to be vindicated.<br /><br />2. There was no evidence that policy makers think about fundamental ethical and value issues. If they do, it is probably along the lines of particular moral dilemmas, winners and losers in resource allocation etc, not really about whether or not the service should be a sickness or health promoting service, what its real long-term priorities should be etc. Strategy is pragmatic and piecemeal in the unthinking rather than the cautious and experimental sense. There are a number of structures, consultation processes, and feedback loops, for putting up against policies and making them more critical. However, there is no real evidence of critical discourse in strategy documents (often created to sell things to people, not to explain or engage). Furthermore, despite the formal structures there is a situation of widespread disempowerment and frustration on the ground and a sense that service providers and users at local level have little or no influence on the direction of health care provision and policy. There is no real critical and measured multi-vocal widespread public ethics and values informed discussion about the overall big shape of the NHS. There is no effective deliberative discussion in public on processes of governance and social justice in a situation where management and the roll out of technology seem to have supplanted effective, democratically accountable governance.<br /><br />3. No-one seems to know who the policy writers are and they are held up as aliens. Since no-one knows who they are, it is difficult to know how they relate to the world of ethics and values. But the products of their labours and the way in which they are consulted upon and then implemented suggest that ethics is not a big issue, except perhaps in relation to specific controversial decisions that pose immediate, substantial practical dilemmas. Similarly, we can only speculate on how the public interest is mediated to them. The NHS is so big that it is thought about in bits and pragmatically – a tendency exacerbated by the unrelenting pace of policy development and implementation. This means that ethics and values are missed out except in terms of the implicit and the overtly problematic. The ‘public interest’ appears to be poorly articulated, understood and defined and seems to act as a legitimating concept for various interest groups to elide difficult and problematic decisions. Its invocation often closes down thought and enquiry rather than opening up the kind of wide debate that its invocation might be expected to imply.<br /><br />4. If citizens are to be more engaged in ethically informed discussions of the big picture and major policy decisions an enhanced and better theorised understanding of the health citizen within a state owned and provided medical service must be developed. We do not appear to understand what patients are except respect-worthy individuals whose autonomy must be respected when they are being treated. This is an individualistic, consumer-derived, thin way of understanding citizen service users. We need to reconsider if they can’t be better and more effectively described and thus empowered to take more responsibility. But beyond the reconceptualisation of citizenship, patienthood, professional responsibility and rights, etc, there is also the need to reconceptualise the nature of the NHS and who owns, guards, and promotes health and the public interest. The principles and frameworks of the service need to be re-thought. This will be difficult. It is perhaps not surprising that these issues are arising now. Chaos and radical change prompt thoughts about fundamental purpose and identity, individual and institutional. The character and identity of the service is closely related to the character and identity of groups and individuals within it. This is complex and not easy, but it is not impossible for societies to talk to themselves. Indeed, sometimes complex discussion that builds consensus can make concerted change easier and quicker rather than slowing it down. However, the speed of change is inimical to standing back from the pragmatic.<br /><br /><span style="FONT-STYLE: italic">Emergent issues</span><br /><br />In addition to these main conclusions, a number of important issues emerged:<br /><br /></span><br /><ul style="font-family:trebuchet ms;"><li><span style="font-size:100%;">promoting public health, the greater good of society and health citizenship is to a great extent in unresolved and unreflected upon conflict with the culture of autonomy, choice and individual rights</span></li><li><span style="font-size:100%;">larger concerns about participatory mechanisms in representative democracy, including the acknowledgement that not all public involvement is necessarily right and beneficial just by virtue of involving the public</span></li><li><span style="font-size:100%;">the difficulty of identifying sources for an appropriate social ethic for healthcare in a UK or European context</span></li><li><span style="font-size:100%;">the balance between privileges and responsibilities accruing to patients</span></li><li><span style="font-size:100%;">the vulnerability of idealism and altruism within public administration</span></li><li><span style="font-size:100%;">the political dimensions of resource constraints within health care</span></li><li><span style="font-size:100%;">the limitations of critical and theoretical understanding within medicine of philosophical issues concerning medicine</span></li><li><span style="font-size:100%;">the limitations of public understanding of scientific and other information relating to health</span></li><li><span style="font-size:100%;">the severe poverty of political culture in the UK.</span></li></ul><span style="font-family:trebuchet ms;font-size:100%;"><br /><span style="FONT-STYLE: italic">Conclusion</span><br /><br />The main conclusion of the seminar was that there is a fundamental lack of critical thought and reflection about broad goals and values in contemporary health care policy and provision. In the context of intellectual vacuum, the collapse of effective intermediate structures, and democratic desertification, there promises to be a loss of fundamental direction, purpose and values at the very moment when the NHS needs to clarify its purpose and role. This could be fatal to an organisation upon which many people fundamentally depend – some, indeed, for their lives.<br /><br />We felt that it was vital to begin to establish open public spaces for informed and critical thought and discussion about fundamental aims, values and directions in a publicly owned and run service. Without this, a descent into hasty pragmatism would continue, to the possible detriment of all health service users and employees. The question, What would constitute human flourishing?, needs to be asked and pursued at many different levels in the NHS, with as open a discussion with as many different groups and people as possible. Intellectual ‘plumbing’ (Mary Midgley’s phrase) is required to clarify concepts, values, aims and directions, both immediate and long-term. Thus critical thinking about health needs to be undertaken at all levels of the NHS as a matter of urgency.<br /><br />Practically, a number of suggestions were advanced<br /><br /></span><br /><ul style="font-family:trebuchet ms;"><li><span style="font-size:100%;">establish an interdisciplinary British society to promote broad and serious thought about the policy and practice of health care</span></li><li><span style="font-size:100%;">explore the identity, rights and responsibilities of health care institutions and their users from a value perspective</span></li><li><span style="font-size:100%;">instigate a discussion about the nature of health and the sort of services and institutions that might be appropriate for nurturing it</span></li><li><span style="font-size:100%;">engage academics and intellectuals from all parts of society and the academy in a more fundamental discussion about health, health policy, and practice</span></li><li><span style="font-size:100%;">advocate a much broader critical theoretical approach to health policy and practice in the training of health professionals</span></li><li><span style="font-size:100%;">engage a wider range of policy makers in fundamental discussion about the ends of health policy and practice</span></li><li><span style="font-size:100%;">create interdisciplinary meetings to widely promote this kind of discussion</span></li><li><span style="font-size:100%;">begin to write in publicly accessible ways about fundamental critical and philosophical issues in health policy and practice so that a wide range of people are engaged in discussion about a service which all use and to which all contribute.</span></li><li><span style="font-size:100%;">using education and debate, empower users, providers and policy makers to engage widely in fundamental debates about health and health care</span></li></ul><span style="font-family:trebuchet ms;font-size:100%;"><br />It should be emphasised that most, if not all, participants in the seminar believed that fundamental conceptual and ethical debate is not an optional extra for those who ‘like that sort of thing’ or have the leisure to indulge in it. Without a new, widespread attempt to engage more broadly in the direction and values of the NHS and to involve all citizens appropriately, the service may well arbitrarily fragment. In this context, intellectual plumbing appears vital if the NHS is to have the morals and morale effectively to continue. A critical re-moralisation, involving experts and intellectuals, is therefore fundamental. This requires opening up a new space in the public domain.<br /></span>Yan Yan Leunghttp://www.blogger.com/profile/17830785899548764487noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-89842269010319335912001-01-14T17:59:00.028+00:002013-06-25T11:54:31.592+01:00The NHS as "Civil Association"<span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br /><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Think about Health<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">NHS as Civil Association<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-size: large;">13<sup>th</sup>-14<sup>th</sup> April 2012</span><span style="font-size: small;"><o:p></o:p></span></span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">The objective of this conference was to bring together academics, physicians, charity workers, and others interested in the organisation and provision of health in the UK, in order to discuss its moral and political foundations.&nbsp; The conference was, in part, inspired by Andrew Edgar’s paper&nbsp;<a href="https://docs.google.com/open?id=0B1Ni-H3C2ViTNjgyOWUwODQtNDc2Ni00ZmZmLWEyYWYtNWM5NmVkMGY3ZDZm">'The Health Service as Civil Association'</a>, and the argument that the NHS is to be understood as a civil association.&nbsp; This entails that the provision of health care is expressive of the moral self-understanding of a community, and that open and public discussion over the justice of health care provision is vital to sustaining and legitimating both health care itself, be this at the level of the organisation or in individual practice, and to the sense of community.&nbsp; The conference aimed to provide a forum within which this idea could be debated, but also strove to be a manifestation of civil association and debate over health care.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: Arial, Helvetica, sans-serif;">Programme<o:p></o:p></span></b></div><div class="MsoNormal"><b><span style="font-family: Arial, Helvetica, sans-serif;">13<sup>th</sup> April<o:p></o:p></span></b></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Friday 13th April<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">10.30 Welcome and Introduction.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">11.00&nbsp; Peter Sedgwick (Reader in Philosophy, Cardiff University)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘Michael Oakeshott and Civil Association’</b>&nbsp; <span style="color: red;"><a href="http://mp3%20link/">audio</a><o:p></o:p></span></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">11.30&nbsp; Andrew Edgar (Reader in Philosophy, Cardiff University)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘NHS as Civil Association’&nbsp; </b><span style="color: red;"><a href="http://audio/">audio</a></span><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">12.00 Plenary discussion – academic and professional perspectives&nbsp;<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">12.30 Lunch<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">1.30 Paper: Ruth Appleton (Santé Refugee Mental Health Access Project)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘NHS and the Asylum seeker’</b>&nbsp; <span style="color: red;"><a href="http://audio/">audio</a></span><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">2.15 Malcolm Rigler (North Somerset PCT) and Rob MacDonald (Liverpool John Moores University)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘From Rage to Rebuilding’&nbsp;</b><span style="color: red;"><a href="http://audio/">audio</a>&nbsp;</span></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small;"><o:p></o:p>(To read Robert Macdonald's paper "The Psychiatric Hospital: phenomenological, spatial and architectural experience of mental illness", please click&nbsp;<a href="https://docs.google.com/open?id=0B1Ni-H3C2ViTRld5eHd3djBJS0U">here</a>.)</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">3.00&nbsp; Tea<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">3.30 Key Note Address<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">John Gillies (Chair, Royal Collage of General Practitioners, Scotland)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘The NHS in Scotland and England—reflections of a GP’</b> <span style="color: red;"><a href="http://audio/">audio</a></span><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">4.30 Peter West –Oram (University of Birmingham)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘Civil Association or Commodity?’</b><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">5.15 Close<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"> <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Saturday 14th April<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">9.30 Paper :&nbsp; David Taylor-Gooby (Lay member, Durham Dales, Easington and Sedgefield Commissioning group)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘A Community Ethic’&nbsp;</b></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><o:p></o:p><span style="font-size: x-small;">(To read David Taylor-Gooby's paper "A Community Ethic in Relation to Health", please click&nbsp;<a href="https://docs.google.com/open?id=0B1Ni-H3C2ViTcF9HVXBlcDZuXzQ">here</a>.)</span></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">10.15<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Heather Widdows (Professor of Global Ethics, University of Birmingham)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘Health and Public Goods’</b><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">11.15 Tea/Coffee<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">11.45<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">Paper: Bob Brecher (Brighton University)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>'Kant, the neo-liberal revolution and the NHS'</b><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">12.30 Lunch<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">1.30&nbsp; Panels&nbsp; <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">2.15 Ann Gallagher (Reader in Nursing Ethics, University of Surrey)<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;"><b>‘The Use and Misuse of Dignity in Care’</b><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">3.00&nbsp; Plenary discussion<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">(Responses, future actions)<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial, Helvetica, sans-serif;">4.00 close</span></div><div class="MsoNormal"><br /></div><span style="font-size: 11pt;"><a href="http://www.thinkabouthealth.net/p/april-2013-conference-feedback-robert.html"><span style="font-family: Arial, Helvetica, sans-serif;">Conference Feedback</span></a></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><br /><br /><br /><br />Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.comtag:blogger.com,1999:blog-8944973145355055164.post-7532383007691925932001-01-13T18:53:00.002+00:002012-03-27T18:04:49.644+01:00The NHS as "Civil Association" - Full Programme<br/><span style="font-family: Verdana, sans-serif;"><strong>Friday 13th April</strong></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">10.30 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Welcome and Introduction</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">11.00&nbsp; </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Peter Sedgwick (Reader in Philosophy, Cardiff University) </em></span><span style="font-family: Verdana, sans-serif;"><em>‘Michael Oakeshott and Civil Association’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">11.30&nbsp; </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Andrew Edgar (Reader in Philosophy, Cardiff University) </em></span><span style="font-family: Verdana, sans-serif;"><em>‘NHS as Civil Association’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">12.00 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Plenary discussion – academic and professional perspectives</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">12.30 Lunch</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">1.30 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Ruth Appleton (Santé Refugee Mental Health Access Project) </em></span><span style="font-family: Verdana, sans-serif;"><em>‘NHS and the Asylum seeker’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2.15 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Malcolm Rigler (North Somerset PCT) and Rob MacDonald (Liverpool John Moores University) ‘From Rage to Rebuilding’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3.00 &nbsp; Tea</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3.30 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Keynote Address: John Gillies (Chair, Royal Collage of General Practitioners, Scotland) ‘The NHS in Scotland and England—reflections of a GP’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">4.30 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><em><span style="font-family: Verdana, sans-serif;">Peter West-Oram (University of Birmingham) </span><span style="font-family: Verdana, sans-serif;">‘Civil Association or Commodity?’</span></em><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">5.15 &nbsp;Close</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><strong>Saturday 14th April</strong></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">9.30 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>David Taylor-Gooby (Sunderland; Lay member, Durham Dales, Easington and Sedgefield Commissioning group) ‘A Community Ethic’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">10.15</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Heather Widdows (Professor of Global Ethics, University of Birmingham)</em></span><br /><span style="font-family: Verdana, sans-serif;"><em>‘Health and Public Goods’</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">11.15 &nbsp;Tea/Coffee</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">11.45</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Bob Brecher (Professor of Ethics, Brighton University) Kant, the neo-liberal revolution and the NHS</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">12.30 Lunch</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">1.30&nbsp; </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Panels&nbsp;</em> </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">2.15 </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><em><span style="font-family: Verdana, sans-serif;">Ann Gallagher (Reader in Nursing Ethics, University of Surrey) </span><span style="font-family: Verdana, sans-serif;">‘The Use and Misuse of Dignity in Care’</span></em><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">3.00&nbsp; </span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><em>Plenary discussion (responses, future actions)</em></span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">4.00&nbsp;Close</span><br /><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"></div>Simon Walthohttp://www.blogger.com/profile/13753809084095856021noreply@blogger.com